Ureterorectal diversion with rectal augmentation
Tóm tắt
Uretersigmoidostomy in the adult has progressively been abandoned because of its high complication rate (both metabolic and functional). We have studied the feasibility of a new model of ureterorectal diversion in 12 Beagle dogs, with the aim of increasing rectal capacity and decreasing rectal pressure. A segment of the ileum was isolated and opened along its antimesenteric border to obtain a patch into which the right ureter was implanted, the left ureter being left intact to allow comparison of the kidneys postoperatively. The patch was then sutured to the edges of a large anterior rectotomy. Modifications of rectal physiology were studied by recording the rectal pressure after distension by a latex balloon both preoperatively and 3 months postoperatively, so that it was possible to evaluate the elasticity of the rectal wall. Radiographic studies and examination of autopsy specimens after 3 months yielded the impression of a reservoir added to the rectal space. Intrarectal pressure was significantly decreased (50% of the preoperative value) for a given distension volume following rectal augmentation (P<0.01). The elasticity of the rectal wall was not modified but the capacity of the reservoir was increased. The ureteroileal implantation was patent in two of the five evaluable dogs out of seven implantations performed. In these cases, signs of pyelonephritis were found in the right kidneys. In the remaining cases the implantation became obstructed for reasons mainly related to canine anatomy and experimental conditions. These technical difficulties in the dog make it impossible to assess the quality of this reimplantation technique in this model. After this type of rectal augmentation in ureterorectal diversion, a highquality reservoir can be obtained leading to significantly lower rectal pressure than preoperatively for a given volume of distension. This suggests that the upper urinary tract may be better protected than after classic ureterosigmoidostomy and continence may be improved, making this technique suitable for clinical trials.
Tài liệu tham khảo
Arhan P, Faverdin C, Persoz B, Devroede G, Dubois F, Dornic C, and Pellerin D (1976) Relationship between viscoelastic properties of the rectum and anal pressure in man. J Appl Physiol 41:677
Benoit G, Boccon-Gibod L, Steg A (1982) Ureterosigmoidostomy by the “cuff” procedure. The risk of stenosis (in french). Ann Urol 1:79
Bouchoucha M, Denis P, Arhan P, Faverdin C, Hero M, Devroede G, Pellerin D (1989) Morphology and rheology of the rectum in patients with chronic idiopathic constipation. Dis Colon Rectum 32:78
Boyd SD, Kauman JJ, Goodwin WE (1989) Successful use of transureterostomy to salvage ureterosignoidostomy after anastomotic failure. Urology 33:271
Coolsaet BL, Weiss RM (1984) Clinically applicable upper tract urodynamics: state of the art. World J Urol 2:168
Daniel O (1961) The complications which follow diversion of the urinary stream. Ann R Coll Surg Engl 29:205
Daniel O, Singh ML (1969) Measurement and control of bowel pressure in ureterocolic anastomosis. Br J Urol 41:32
Graversen PH, Gasser TC, Friedmann AL, Bruskewitz C (1988) Surveillance of long-term metabolic changes after urinary diversion. J Urol 140:818
Kock NG, Berglund B, Ghoneim MA, Lindholme E, Lycke KG, Virseda J (1988) Urinary diversion to the augmented and valved rectum. Scand J Urol Nephrol 22:227
Kock NG, Ghoneim MA, Lycke KG, Mahran MR (1988) Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure. J Urol 140:1375
Le Duc A, Camey M, Teillac P (1987) An original antireflux ureteroileal implantation technique: long-term follow up. J Urol 1156
Mazeman E, Biserte J, Cracco D, Bailleul JP (1986) Ureterosigmoidostomy after total cystectomy. 50 observations (in french). Chirurgie 112:323
McConnell JB, Stewart WK (1975) The long-term management and social consequences of ureterosigmoid anastomosis. Br J Urol 47:607
Miller K, Matsui U, Hautmann R (1990) The functional rectal bladder prevention of hyperchloremic acidosis following vesicosigmoidostomy in dogs. J Urol 144:375
Spinak JP, Caldamone AA (1986) Ureterosigmoidostomy. Urol Clin North Am 13:285
Wear JB, Barquin OP (1973) Ureterosigmoidostomy. Long-term results. Urology 1:192